Medical Reviewer

Maximus Federal we are seeking 1099 NP providers for a remote Medical Reviewer role.

Please see the additional information below.

Please feel free to reach out if you have any additional questions.

100% Remote 1099 Independent Medical Reviewer roles available for APRN/CRNP for General Surgery

Project

VACPR ( VA Clinical Peer Reviews) uses a process called Peer Review for Quality Management and it may only be used for improving the quality of health care or utilization of health care resources in VA medical facilities. Its primary focus is whether the clinical decisions and actions of a clinician during a specific clinical encounter met the standard of care.

Cases will be assigned to providers based off the request and specialty requested. A provider has 24hours to accept or decline a case. The caseload varies month to month and is based upon what the VA sends Maximus and the specialty requested.

Provider is required to complete and return the completed review within 3 days of accepting a case for Audit/Facility/Management Reviews and within 5 days of accepting a case for Medical Advisory Opinion Reviews.

Audit Reviews – random peer reviews. Time to complete approx. 30 minutes to 1 hour.

Facility-Requested Reviews and Management Reviews – triggered reviews due to someone being readmitted in 30 days, deaths, special investigations. Time to complete approx. 30 minutes to 1 hour.

Medical Advisory Opinions - can be any specialty, Veteran has filed a tort claim, determination assists Attorney review to determine if they will go to court or settle out of court. Time to complete approx. 2-3 hours.

Clinical Appeals – infrequent reviews providing recommendations regarding whether appropriate and/or reasonable and necessary clinical service was provided and/or denied by VA for a group of cases. The rate is hourly, but we have not had one as yet (in 2 years).

Quality Reviews – end of line quality reviews to ensure completion of all form requirements and accuracy of reviews prior to submission to the VA. Time to complete peer reviewers approx. 30 minutes; MAOs 1-2 hours.

Deliverable: -Medical record review only, no in-person exams, will not be called into court to testify. Form based reviews (question and answer). Providers written assessments shall integrate the following: Evidence from medical records/case documents

--Reviewers' clinical expertise and advisory opinions (not expert opinions)

--Citations that are scientific and evidence based

--If required, the Reviewer shall provide further clarification of information of a completed review and respond promptly to inquiries by email and/or phone.

System/Tools: Equipment: Provider must have their own computer for the following:

Complete training online

Complete written reviews using MS word software program

Be able to access VA EMR system to review medical records,

Be able to access Maximus’ secure email system to receive encrypted emails.

Systems:

Utilize the VA Electronic Medical Records system or Community viewer (VA system). Reviewers will be provided a login and how to navigate through the system during training prior to being assigned any cases.

Due Date: Case Acceptance: Cases will be assigned to providers based off the request and specialty requested. A provider has 24hours to accept or decline a case. The caseload varies month to month and is based upon what the VA sends Maximus and the specialty requested.

Deliverable Due: Provider is required to complete and return the completed review within 3 days of accepting a case for Audit/Facility/Management Reviews and within 5 days of accepting a case for Medical Advisory Opinion Reviews.

Volume:

Varies greatly depending in the specialty.

60-75% of cases are received within the first 2 weeks of a month.

VA will often need special reviews in a particular specialty where they need 10-15 cases done which are all received at the same time or they all need to be done by the same Reviewer (in this case we can negotiate to have the assignment spread out, generally 5 cases per week).

Training:

Self-pace videos (made available while VA is doing background check) require completion. You will be trained on how to access the VA medical records using (Community Viewer). Template forms and additional reference material will be accessible to reference as you complete these reviews. Program Staff are available to assist as needed.

Review Examples:

Audit Reviews – random peer reviews. Time to complete approx. 30 minutes to 1 hour.

Facility-Requested Reviews and Management Reviews – triggered reviews due to someone being readmitted in 30 days, deaths, special investigations. Time to complete approx. 30 minutes to 1 hour.

Medical Advisory Opinions - can be any specialty, Veteran has filed a tort claim, determination assists Attorney review to determine if they will go to court or settle out of court. Time to complete approx. 2-3 hours.

Clinical Appeals – infrequent reviews providing recommendations regarding whether appropriate and/or reasonable and necessary clinical service was provided and/or denied by VA for a group of cases. The rate is hourly, but we have not had one as yet (in 2 years).

Quality Reviews – end of line quality reviews to ensure completion of all form requirements and accuracy of reviews prior to submission to the VA. Time to complete peer reviewers approx. 30 minutes; MAOs 1-2 hours.

Payment:

$100/cs

Clinical Appeals (rare

$50/cs

Executive Summary Reports

$100/cs

Facility-Requested Review

$150/cs

Medical Advisory Opinion

$60/cs

Peer Review

$50/cs